Ankylosing spondylitis is a long-term disease that causes inflammation of the joints between the spinal bones and the joints between the spine and the pelvis. It eventually causes the affected spinal bones to join together.

See also: Arthritis

The cause of ankylosing spondylitis is unknown, but genes seem to play a role.

The disease most frequently begins between ages 20 and 40, but may begin before age 10. It affects more males than females. Risk factors include a family history of ankylosing spondylitis and male gender.

The disease starts with hip or low back pain that comes and goes and is worse at night, in the morning, or after inactivity.

Back pain may begin in the sacroiliac joints (between the pelvis and the spine) and involve all or part of the spine.

Pain may go away by bending over. You may not be able to fully expand your chest because of the involvement of the joints between the ribs.

Specific symptoms:

• Chronic stooping to relieve symptoms
• Eye inflammation
• Fatigue
• Heel pain
• Hip pain and stiffness
• Joint pain and joint swelling in the shoulders, knees, and ankles
• Limited expansion of the chest
• Limited range of motion, especially involving spine and hips
• Low-back pain that is worse at night, in the morning, or after inactivity
• Loss of appetite
• Neck pain
• Slight fever
• Stiffness and limited motion in the low back
• Weight loss

Tests may include:

• CBC
• ESR
• HLA-B27 antigen
• X-rays of the spine and pelvis

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.

Corticosteroid therapy or medications to suppress the immune system may also be prescribed. Drugs called TNF-inhibitors (etanercept, adalimumab, infliximab), which block an inflammatory protein, have been shown to improve the symptoms of ankylosing spondylitis.

Some health care professionals use drugs that block cell growth (cytotoxic drugs) in people who do not respond well to corticosteroids or who are dependent on high doses of corticosteroids.

Surgery may be done if pain or joint damage is severe.

Exercises can help improve posture and breathing. Lying flat on the back at night can help maintain normal posture.

The course of the disease is unpredictable. Symptoms may come and go at any time. Most people are able to function unless the hips are severely involved.

Damage of bone and cartilage can lead to fusing of joints in the spine or other areas, which can interfere with your ability to move. It can be extremely painful and crippling. The heart, lungs, and eyes may also become affected.

Complications include:

• Eye inflammation (uveitis)
• Heart valve disease, typically aortic valve stenosis
• Inflammation of the aorta
• Pulmonary fibrosis

Call your health care provider if you have symptoms of ankylosing spondylitis or if you have ankylosing spondylitis and new symptoms develop during treatment.

Prevention is unknown. Awareness of risk factors may allow early detection and treatment.

Goldman L, Ausiello DA. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

Sidiropoulos PI, Hatemi G, Song IH, et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists. Rheumatology (Oxford). 2008. 47(3):355-61.

Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database, Syst Rev. 2008. (1):CD002822.